Do doctor-politicians have an advantage in the health care debate?
By: Daniel Libit July 28, 2009 04:38 AM EST

Rep. Tom Price, an orthopedic surgeon and chairman of the House Republican Study Committee, donned his figurative white coat last Wednesday and issued a grim prognosis about the Democrats’ health plan. “In the Hippocratic Oath I took to become a physician, the phrase ‘I will keep [my patients] from harm and injustice ...’ remains dear to me,” Price blasted in an e-mail, “not only as a physician but now as a member of Congress.”

“I have devoted my life to keeping my patients healthy and safe, and now I apply those same principles to my constituents in Georgia’s 6th District. With that said, the Democrats’ current plan in the U.S. House is detrimental to America’s well-being.”

The not-so-implicit message: When it comes to health care reform, doctors know best.

But do they?

Some experts — and even some doctor-politicians — say that having an M.D. after your name doesn’t necessarily mean that you’re smarter than the next member of Congress on health care reform. And conflating a medical background with legislative duties can be problematic.

“I don’t think it’s very important,” says Rep. Ron Paul (R-Texas), an obstetrician. “Doctors are like people, and they come from all stripes. And if you brought those 16 doctors in here and sat down and listened to our conversation, I don’t think you’d say, ‘You know, that guy makes a lot of sense.’ They are no better than their political philosophies.”

Howard Dean, a physician and former Vermont governor and Democratic National Committee chairman, says he “sadly” agrees that when it comes to his medical colleagues in the Congress, “like everyone else, they seem to vote their ideology more than their profession.” Dean adds that doctors often do not have finance or executive experience, which would provide valuable wisdom for this debate.

There are currently 16 physicians in Congress: 14 in the House (plus two dentists) and two in the Senate. That adds up to more members with medical degrees than at any time during the decades-long modern health care debate.

On the Senate side, Republican Conference Chairman Lamar Alexander of Tennessee has put his two docs to work. Sens. Tom Coburn (R-Okla.) and John Barrasso (R-Wyo.) have taken to the Web with a weekly online video program called “The Senate Doctors Show.” The videos, which run 25 minutes or so in length, are posted on the Senate Republican Conference website.

But the medicos on Capitol Hill must decide how much they should assert their reputations. And the question has parallels to other congressional debates. During the Iraq war debate, special deference inside and outside the Beltway was paid to lawmakers with military backgrounds. Sens. Jack Reed (D-R.I.) and John McCain (R-Ariz.) and Rep. John Murtha (D-Pa.) became ascendant voices in the Senate and the House. Similarly, when the topic is judicial, those with law degrees rise to the top of the conversation. But Darrell West, director of governance studies at the Brookings Institution, thinks the same does not, and should not, apply to those with medical backgrounds.

“Everybody thinks they know something about health care, because we all go to doctors,” says West. “Not everybody has practiced in a courtroom or been on a battlefield, so the expertise in those areas counts for more than what is true with physicians.”

In some measure, the question of a doctor’s credibility is a debate about the debate itself. Is health care reform, at its root, really about medicine? Or is it about economics? Or social justice? Or all of the above?

“This is really a bill that is not about health care,” says former Republican Rep. Mickey Edwards, a lecturer at Princeton University.

“It is about what role should the government play in taking care of a portion of Americans that don’t have health insurance, and what price should we be willing to pay to meet that need.”

A Gallup study last month indicates that those, like Price, who are laying their M.D.’s on the line may be taken more seriously. Almost three-quarters of respondents said they trust doctors most when it comes to health care reform — more than health care professionals and researchers, more than President Barack Obama and significantly more than the Democratic or Republican leaders in Congress.

The study also found that while Republican voters tend to be more trusting of doctors’ opinions on health care reform than Democratic voters are, physicians are also trusted by a strong majority of Democrats.

The survey didn’t directly address the reputations or trustworthiness of doctors in Congress, but Price says of that group, “Each and every one of us has great experience that ought to be at least given some credibility in this debate.”

There are pitfalls for doctor-politicians who have tried to leverage their medical wisdom in a political setting. Consider the 2005 Terri Schiavo end-of-life case.

Arguing that federal courts should intervene in the removal of Schiavo’s feeding tube, Sen. Bill Frist (R-Tenn.), a heart surgeon, took to the floor of the Senate claiming that his analysis of Schiavo videotapes led him to conclude that she was not in a persistent vegetative state. Frist was later forced to back off those claims, and he was savaged by critics.

The other challenge for doctor-politicians like Barrasso is they run the risk of being perceived as representing a special-interest group. The Republican senator was once president of the Wyoming Medical Society, which lobbies on behalf of physicians.

“The biggest problem is they are seen to be spokesmen for financial reimbursement through the entitlement system,” acknowledged Robert Moffit, a former health official in the Reagan administration who now directs the Center for Health Policy Studies at The Heritage Foundation.

Adds West: “I think being a physician is a tricky political platform, because people like their current medical care, but they hate the system as a whole. So what any political opponent is going to do is to turn a doctor into the face of what people don’t like about health care.”

Moffit says if doctors “frame policy in how policy affects their ability to practice medicine, their influence can be decisive.”

He points to the late-’90s push for a patient’s bill of rights, which ultimately manifested bills in both the Senate and the House in 2001. The House legislation, the Bipartisan Patient Protection Act, was led by former Georgia Rep. Charles Norwood, a dentist, and former Iowa Rep. Greg Ganske, a plastic surgeon who was the bill’s sponsor.

But Moffit thinks that even though the health care debate goes well beyond stethoscopes, a doctor necessarily has an important perspective on the entire medical system. Medicare alone, he says, has given physicians “a tremendous amount of experience in dealing with government.”

Even though he’s carrying the flag for the Republicans, Barrasso says that the shared experience of being a doctor would likely make members with medical backgrounds see eye to eye on “80 percent of the general principles” of health care reform, regardless of which side of the aisle they sit on.

Price concurs: If the 16 medical doctors in Congress huddled in the same room, he’s convinced they could, “in relatively short order, hammer out a positive patient-centered solution that we could present in a bipartisan way to the Congress.”

Rep. Jim McDermott (D-Wash.), a psychiatrist who is the fourth-ranking Democrat on the House Ways and Means Committee, thinks that while doctors may be well-equipped to work out the details of a health care program, their “ideology gets in the way of something broader that needs to be done.”

And while arguing for the implicit wisdom they bring to Congress, Barrasso tries to distinguish between the medical practitioners, attacking McDermott as “a psychiatrist [who] probably has not practiced medicine for 25 years.”

Barrasso continues: “I’m talking as somebody who has practiced medicine [since] two years ago, still gets back every weekend, goes to the hospital, goes to the operating room, visits with physicians, nurses. No matter where I go, I am recognized as a doctor first.”